Category: Revenue Cycle Management

key-characteristics-for-successful-downside-risk-contracting

Key Characteristics for Successful Downside Risk Contracting

Organizations that do strong vendor relationships, invest in the organization, and are willing to take on commercial risk will be poised to take on downside risk financial contracts. Through working with population health management vendors, KLAS released a recent report identifying which of their customers are most advanced in adopting downside risk contracts. In the […]
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The Leaders Say Efficiency, Not Finances, Is Top Rev Cycle Rpa/ai Benefit

More than 80% of leading health systems that are using RPA/AI say their primary reason for investing in the technology was improving financial performance, but once the technology was in use, they said efficiency was the top benefit. The reasons that leading health systems initially invest in robotic process automation (RPA) and artificial intelligence (AI) […]
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Telehealth Reimbursement Needed to Address Demand, Staffing Issues

  About 41% of primary care clinicians say going back to pre-pandemic telehealth reimbursement rules would kill virtual care at their practices and exacerbate staffing issues. The survey conducted in mid-August by the Larry A. Green Center, in collaboration with the Primary Care Collaborative (PCC), found that primary care practices have come to rely on […]
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Optum partners with SSM Health and will employ certain revenue cycle staff

To reduce care variation, SSM and Optum will use clinical technologies, advanced analytic and data-driven insights at the point of care. Certain SSM Health revenue cycle staff and hospital care management will become employees of Optum. They will continue to work in their current locations across Illinois, Missouri, Oklahoma and Wisconsin. WHY THIS MATTERS As […]
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87 Contracts Score 5 Stars on 2022 Medicare Advantage Star Ratings

On average, Medicare Advantage-prescription drug plans scored 4.37 stars for the 2022 Medicare Advantage Star Ratings. Over nine in ten Medicare Advantage-prescription drug plans (94.26 percent) received a 3.5 star rating or higher on the 2022 Medicare Advantage Star Ratings, with an average star rating of 4.37 stars, CMS announced. In contrast, in 2019 over […]
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Medicare Advantage COVID-19 Hospitalizations Were Lower Than FFS

Medicare Advantage coronavirus-related hospitalizations were lower than fee-for-service  Medicare’s rates from January through November 2020, a Better Medicare Alliance report found. ATI Advisory compiled the report on behalf of Better Medicare Alliance using data from the MCBS Fall 2020 Community Supplement Public Use Files and Medicare Claims Data. Overall, Medicare beneficiaries experienced hospitalization for coronavirus […]
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Major insurers running billions of dollars behind on payments to hospitals and doctors

Anthem Blue Cross, the country’s second-biggest health insurance company, is behind on billions of dollars in payments owed to hospitals and doctors because of onerous new reimbursement rules, computer problems and mishandled claims, say hospital officials in multiple states. Anthem, like other big insurers, is using the COVID-19 crisis as cover to institute “egregious” policies […]
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Top Challenges of the Merit-Based Incentive Payment System

  The Government Accountability Office (GAO) analyzed performance data from providers who participated in the Merit-Based Incentive Payment System (MIPS) between 2017 and 2019 and found that some providers experienced MIPS challenges. Under MIPS, CMS monitors provider performance in four different categories: quality, improvement activities, promoting interoperability, and cost. The providers receive scores in each […]
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